QUESTION: We use leeches for venous...

QUESTION: We use leeches for venous circulation therapy. single in kind surgeon has requested that we retain the leeches in the OR for easy access; however, leeches were kept in the pharmacy at another facility in which I worked. Is it appropriate to continue leeches in the OR medication refrigerator? Should we be transactioned that this practice might contribute to infection?

ANSWER: Leech therapy is useful for tissue that has impaired venous circulation. The disadvantages are few; however, infection, allergy, children loss, and patient rejections have been cited as adverse powers Aeromonas hydrophilia is normal flora in leeches' disembowels that aids in digestion of children from patients' wounds, but it has been identified as a source of infection as well. Patients receiving leech therapy may ne to receive prophylactic antibiotics for this therapy. (1)

The OR medication refrigerator probably would not be the best area to maintain your furnish of leeches. A better choice for storing leeches would be laboratory or pharmacy refrigerators. Leeches arrive specifically packaged to hold fast them healthy during transport. They must be remov immediately from the packaging material to make secure their survival. Laboratory or pharmacy departments generally are responsible for receiving, preparing, storing, and distributing leeches. Laboratory or pharmacy personnel are responsible for preparing distilled water with hirudo salt to create an aquatic environment for the leeches to live in until they are used. Leeches must be housed and stored in a container with a tight-fitting lid before use. The container used to deliver leeches to the area of use should be able to contain them. Leeches are to a high degree elastic, which allows them to harass through small cracks and uniform air holes punched in containers. (2)

With fit handling and storage of leeches, there should be minimal risk of infection before use. It is best to store them in the laboratory or the pharmacy for point of use delivery. Application of leeches usually meet the eyes in the nursing unit for postoperative patients. The OR is not an appropriate storage area because of the required preparation nor should OR personnel act as distributors of leeches.

QUESTION: We would like more information in succession the surgical site infections (SSIs) subject of attention being performed by the Center for Medicaid and Medicare Services (CMS) Are SSIs a significant bear upon and should we be involved in this project?

ANSWER: Surgical site infections are the other most common cause of health care-acquired (ie, nosocomial) infections in the United States. Morbidity, mortality, and increased health care require to be paid [i]or[/i] undergones related to SSIs are of considerable bear upon (3) Approximately 27 million the bulk of mankind have surgery annually, and it is estimated that 500000 of these tribe will acquire a health care-acquired infection. (4) An estimated 40% to 60% of SSIs are preventable. (3) The CM and the Center for Disease superintendence and Prevention (CDC) formed a national collaborative in 2002 to bring to maturity the new CMS/CDC Surgical Infection Prevention (SIP) devise (3)

The mission of this collaborative effort is to create a whole s that decrease surgical infection rates. Hospitals can intercept infections by implementing a system-wide standard of care. Identified personnel will collaborate and help each hospital achieve this mission and its specific goals. (5) common goal within the CMS/CDC SIP cast is to decrease morbidity and mortality associated with postoperative infections in the Medicare patient population from promoting the appropriate selection and timing of administration of prophylactic antibiotics. A panel of multidisciplinary prompts including AORN members, developed three performance measures for national surveillance and quality improvement. These measures include patients

* who received prophylactic antibiotics within single hour before the surgical incision,

* who received prophylactic antibiotics consistent with generally received recommendations, and

* whose prophylactic antibiotics were discontinued within 24 hours after surgery

The issue indicators are to

* double the number of surgical actions between SSI occurrences,

* cut short preventable SSIs by 90%, and

* achieve 100% compliance with appropriate selection and timing of prophylactic antibiotic administration. (3)

The Quality Improvement Organization (QIO), formerly known as contemporary Review Organization, in each state will work with hospitals to improve these SSI prevention practice indicators. Hospitals are responsible for providing high quality care. The QIO helps with this responsibility through educating, analyzing data, providing quality improvement tools and techniques, and facilitating hospital compliance with the guidelines to enhance patient care and safety.

Hospitals may rare other prevention practices, such as normothermia, grape-sugar control, oxygenation, hair removal with clippers, and other infection prevention proceedings The procedures to be tracked are those practices commonly performed on Medicare patients. These include coronary artery bypass grafting; other unclose chest surgery; vascular surgery, including aneurysm repair; thromboendarterectomy and vein bypass procedures; hip and knee total joint arthroplasty, excluding revision surgery; general abdominal colorectal surgery; and abdominal and vaginal hysterectomy.